Adjustable limb support system

ABSTRACT

An adjustable limb support system is provided for an operating room table to adjustably orient and position a stirrup or boot. The support system provides an adjustable support in combination with a vertically adjustable support. The vertically adjustable support includes a support arm, a ratchet wheel, a lock pin, and a ratchet release. The support arm is connected to a housing which both rotate about the ratchet wheel in a rotational plane extending upwardly and outwardly from the operating room table for automatic abduction. The lock pin engages the ratchet wheel and allows the support arm to be rotated upwardly but not downwardly. The ratchet release disengages the lock pin and allows the support to be rotated downwardly. The support arm can thus ratchet upwardly to fixed vertical positions and be lowered only by disengaging the lock pin. The adjustable support includes a retaining block, a compression block, and a compression head. The retaining block defines a passage for receiving a connecting rod secured to the stirrup or boot. The compression block defines a passage for receiving the support arm of the vertical adjustable support. The compression head when tightened prevents translation and rotation of the compression block on the support arm, and rotation of the compression block and the retaining block relative to each other. When the compression head is untightened the compression block can be translated or rotated on the support arm, and the blocks can be rotated relative to each other, in order to orient and position the stirrup or boot. The stirrup or boot freely rotates or swings about the axis of the connecting rod at all times.

This is a continuation-in-part of application Ser. No. 08/265,647, filedJun. 24, 1994.

BACKGROUND OF THE INVENTION

The present invention generally relates to an adjustable support systemfor holding in place the limb of a person during surgery, and morespecifically, to such a system having an adjustable support incombination with a vertically adjustable support.

Adjustable support systems are known in the prior art. For example, U.S.Pat. No. 4,564,164 describes an adjustable support system havingrotational and translational freedom. The system can be adjusted to adesired position and locked in place by one handle. In a limb supportapplication, a limb support is attached to the adjustable support systemwith a bracket and the adjustable support system is attached to anoperating room table with a rod. The rod is positioned horizontally, andhas a right angle bend to a vertical portion which is clamped in asocket located on a side of the operating room table. The height androtational position of the limb support are adjusted by moving androtating the vertical portion of the rod within the socket. While thesupport system has rotational and translational freedom adjustable byone handle, the system has minimal height adjustment. The minimal heightadjustment severely limits the number of positions that can be obtainedto expose the patient. The vertical height of the system also cannot bereadily adjusted during surgery and requires a minimum of two people tomake the adjustment. Additionally, because the rod remains in ahorizontal position, the rod may impair the access of assistantsstanding beside the doctor.

Limb supports incorporating various ratchet mechanisms for adjustingtheir vertical position are also known in the prior art. For example,U.S. Pat. No. 2,679,445 discloses a support for a stirrup on aphysician's examining table. The stirrup bar ratchets upward to positionthe stirrup at a desired height. While the stirrup support does have avertical height adjustment, the stirrup can only be adjusted and lockedin position lengthwise along the stirrup bar. Additionally, the stirrupcan only be rotated about one axis and the position cannot be locked inplace. The limb support system, therefore, has a limited number ofpositions that can be obtained to expose a patient during a procedure.See also U.S. Pat. Nos. 1,823,248, 891,679, and 891,678 for related limbsupport systems wherein a ratchet mechanism adjusts the vertical heightof a limb support.

U.S. Pat. No. 5,157,800 discloses a foot section for a birthing bed. Aplate ratchets upward about its base to adjust the vertical position ofa calf support. The calf support is mounted to the plate by means of aball joint. The ball joint allows the angular position of the calfsupport to be adjusted and locked in place. While the calf support doeshave a vertical height adjustment and rotational freedom that can belocked, it does not have the freedom to translate along or away from theplate. The system, therefore, has a limited number of positions that canbe obtained to expose a patient during a procedure. Moreover, the calfsupport's lack of translational freedom away from the vertical supportmay impair the access of assistants standing beside the doctor.

U.S. Pat. No. 612,373 discloses a physicians table. An arm ratchetsupward about its base to adjust the vertical position of a stirrup. Thestirrup position can be adjusted by translation lengthwise along the armand radially away from the axis of the arm. Each adjustment, however, islocked in position by separate thumb-screws. Additionally, the stirrupcan only be rotated about one axis and the position cannot be locked inplace. The limb support system, therefore, has a limited number ofpositions that can be obtained to expose a patient during a procedure.Moreover, the available adjustments cannot be readily made during aprocedure.

Each of the aforementioned patents are incorporated herein in theirentirety by reference.

In general the prior art limb support means are able to hold a limbduring surgery. However, some prior art limb supports lack a verticaladjustable support. Other prior art limb supports do not have bothrotational and translational freedom. Yet other prior art limb supportsdo not lock the limb support position, do not lock the limb supportposition with one device, or fully lock all freedom of the limb support.In each case, the results are unsatisfactory. Therefore, there is a needin the art for an improved limb support system.

SUMMARY OF THE INVENTION

The present invention provides an adjustable limb support system bycombining an adjustable support that orients and positions a stirrup orboot that supports a person's limb, and a vertically adjustable supportwhich readily ratchets to adjust the height of the adjustable supportand the stirrup or boot. The vertically adjustable support rotates in aplane of rotation extending angularly outwardly from the side of thetable. The adjustable support is adapted for rotation of the stirrup orboot about an axis generally perpendicular to a plane of rotation of thevertically adjustable support, and two axes at right angles to the firstaxis. In a locked state the adjustable support locks the orientation ofthe stirrup or boot about the two axes, but the stirrup or boot floatsor freely swings about the axis generally perpendicular to the plane ofrotation of the vertically adjustable support. The result achieved bythe combination of the adjustable support and the vertical adjustablesupport, is a support system that holds the patient's limb in positionswhich expose areas of the patient for surgery in ways never beforeobtainable. In addition, the combination gives one person the ability tomake quick adjustments to the patient's position during a procedure andprovides an access area for technicians to work along the side of thedoctor.

In the present invention, the vertically adjustable support is providedto position the stirrup or boot and the adjustable support to variousheights and different abduction angles. The vertically adjustablesupport comprises a support arm, a ratchet mechanism, a ratchet release,and an attachment. The adjustable support is secured to the support armand is supported thereby. The ratchet mechanism allows the support armto be readily rotated to fixed positions by simply applying a force tothe support arm. The ratchet mechanism will not allow the support arm tobe rotated back, therefore, a ratchet release is provided. Theattachment enables the vertically adjustable support to be secured to anoperating room table.

The adjustable support is provided to orient or position the stirrup orboot at each height or fixed vertical position and partially lock it inplace. In an unlocked state the adjustable support, and the attachedstirrup or boot, can be rotated about the support arm of the verticallyadjustable support. Additionally, the stirrup or boot can be rotatedabout a second axis generally perpendicular to the support arm of thevertically adjustable support. In a locked state the adjustable supportis locked to prevent the above stated rotations. The stirrup or boot cangenerally rotate or swing at all times about a third axis which is atright angles to the first and second axes.

It is a principle feature of the present invention that it provides asupport system wherein the position and orientation of the stirrup orboot is adjustable at each of several heights or vertical positions. Itis another feature of the present invention that it provides a supportsystem that positions the patient during surgery to provide exposures ofthe patient that could not previously be obtained. It is a furtherfeature of the present invention that it provides a support system thatcan be easily adjusted or positioned quickly and by one person.

It is an important feature of the present invention that it provides acombination of the adjustable support and the vertically adjustablesupport to allow the doctor to readily position or reposition the bootduring a procedure as it becomes necessary. It is another importantfeature of the present invention that it provides a verticallyadjustable support that can be vertically adjusted to positions otherthan horizontal so that assistants can stand and work beside the doctorwithout reaching over a horizontally positioned and when adjustedprovides automatic exposure for technicians to work. It is a furtherimportant feature of the present invention that the stirrup or bootfloats or freely rotates about the axis generally perpendicular to therotational plane of the vertically adjustable support so that the bootautomatically adjusts when the height or vertical position is changed.It is yet a further feature of the present invention that it provides anangled or bent attachment in order that the vertically adjustablesupport extends angularly outwardly from the operating room table toobtain automatic abduction of the patient. It is also a further featureof the present invention that it provides a vertical adjustable supporthaving a maximum angular position that reduces patient risk due toexcess hip flexion.

The foregoing and other objectives, features, and advantages of thepresent invention will be more readily understood upon consideration ofthe following detailed description of the invention in conjunction withthe accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will hereafter be described with reference to thedrawing figures, wherein:

FIG. 1 is a perspective view of a vertically adjustable support;

FIG. 2 is an elevational view, partially in cross section, of thevertically adjustable support of FIG. 1 with the lock pin in a lockedposition;

FIG. 3 is a plan view, partially in cross section, of the verticallyadjustable support of FIG. 2;

FIG. 4 is an elevational view, partially in cross section, of thevertically adjustable support of FIG. 2 with the lock pin in a releasedposition;

FIG. 5 is a perspective view of a first embodiment of a limb supportsystem including the vertically adjustable support of FIG. 1;

FIG. 6 is a perspective view of an adjustable support;

FIG. 7 is a side elevational view of a ratcheting table clamp;

FIG. 8 is a front elevational view of the ratcheting table clamp of FIG.7;

FIG. 9 is a cross-sectional view taken along line 9--9 of FIG. 7;

FIG. 10 is a perspective view of a second embodiment of a limb supportsystem including the ratcheting table clamp of FIG. 7;

FIG. 11 is a side elevational view of a variation of the ratchetingtable clamp of FIG. 7; and

FIG. 12 is a rear elevational view of the ratcheting table clamp of FIG.11.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

An adjustable limb support system according to a first embodiment of theinvention is shown in FIG. 5. The system comprises a verticallyadjustable support 8, a floating or swinging boot 10, and an adjustablesupport 12.

The vertically adjustable support 8 is best shown in FIG. 1. At one endof the vertically adjustable support 8 is an attachment 90 which securesthe vertically adjustable support 8 to an operating room table 14 (asshown in FIG. 5). The attachment 90 is fixed to a ratchet mechanism 40.The ratchet mechanism 40 allows a support arm 20 to rotate upwardly tofixed angular positions. At an end of the support arm 20 opposite theattachment 90 is a ratchet release 60 which allows the support arm 20 torotate downwardly to fixed angular positions.

A detailed view of the preferred embodiment of the vertical adjustablesupport 8 is shown in FIGS. 2 and 3. The support arm 20 comprises a tube24 and a housing 22. The housing 22 has two cylindrically shapedcavities perpendicular to each other. The first cavity is open at eachend while the second cavity is open at one end and opens into the firstcavity at the other end. The second cavity has a step 23 between twodiameters, with the larger diameter towards the open end. The largerdiameter of the second cavity is internally threaded 32. The two openends of the housing's 22 first cavity are covered by end caps 26, 27which are each attached to the housing 22 by two flat head screws 28.

The tube 24 is circular in cross-section and contained at one end withina tube housing 30. The tube housing 30 is tubularly shaped and has athreaded outer surface 32 which mates with the internal threads of thehousing's 22 second cavity. The inner diameter of the tube housing 30 issized to receive the outer diameter of the tube 24. The outer diameterof the tube 24 is sized to mate with the adjustable support 12 (as shownin FIG. 5).

It will be observed that other embodiments of the support arm 20 knownto those skilled in the art are possible. For example, the tube 24 couldhave a forked-end which sits astride the ratchet wheel 42 and pivotsabout a pin in the center of the ratchet wheel 42.

The ratchet mechanism 40 consists of a ratchet wheel 42 and a lock pin46 as seen in FIG. 2. The outer diameter of the ratchet wheel 42 issized to fit within the first cavity of the housing 22 so that thehousing 22 and the tube 24 can rotate around the ratchet wheel 42 aboutthe centerline of the housing's 22 first cavity and ratchet wheel 42.

As seen in FIG. 2, the outer diameter of the ratchet wheel 42 has aplurality of serrations 44. Each serration 44 has a rounded upper edgeand a radial lower edge. The lock pin 46 has a protruding end 47 shapedto engage the ratchet wheel 42 serrations 44 and lock the housing 22 andthe tube 24 in position. The ratchet wheel 44 of the preferredembodiment has five serrations 44 which lock the tube 24 in five fixedangular positions. It will be observed that a greater or fewer number offixed angular positions could be utilized. The fixed positions of thepreferred embodiment are -26, 0 (horizontal), 26, 52 and 78 degrees. Thezero degree, or horizontal, position is shown in FIGS. 2 and 3. In orderto lock the tube 24 in a fixed position, the lock pin 46 is urged intothe serration 44 by a spring element 50.

It will be observed that other fixed angular positions can be utilized,however, the preferred maximum angular position is 78 degrees in orderto reduce patient risk. A 90 degree position would result in pressure inthe trocar area. If the surgeon requires the patient's limb to bevertical or 90 degrees, it can be accomplished by adjusting thevertically adjustable support to the 78 degree position and gaining anadditional 12 degrees by tilting the table 14. This eliminates thepressure on the trocar area and reduces patient risk of excess hipflexion.

As seen in FIG. 2, the preferred embodiment of the spring element 50 isa helical coil compression spring 52 with a lock body 54 and spring cap56. The spring 52 must have a spring force large enough to hold the lockpin 46 in the serration 44 of the ratchet wheel 42 when a limb is beingsupported. The spring force must also be small enough so that it can beeasily overcome by the ratchet release 60. In the preferred embodiment,the spring 52 is one inch long with a 0.845 inch outer diameter and madeof 0.085 inch diameter music wire. It will be noted that otherembodiments of the spring element 50 known to those skilled in the artare possible, such as a leaf spring.

The lock body 54 is cylindrically shaped having a step 57 between twodiameters, as seen in FIG. 2. The larger diameter is sized to slidewithin the smaller diameter of the housing's 22 second cavity.Preferably the large diameter is recessed 55 to ease sliding within thehousing 22. The smaller diameter is sized to fit within the innerdiameter of the spring 52. The lock pin 46 is fixed to the largediameter end of the lock body 54. The spring cap 56 is tubularly shapedwith an inner diameter sized to slide over the small diameter of thelock body 54, and an outer diameter sized to fit within the innerdiameter of the spring 52. The spring cap 56 also has a flange with adiameter sized to fit within the large diameter of the housing's 22second cavity.

As best seen in FIG. 2 the flange of the spring cap 56 is held againstthe step 23 in the housing's 22 second cavity by the tube housing 30.The spring is retained between the flange of the spring cap 56 and thestep 57 on the lock body 54. Because the spring cap 56 is fixed to thehousing 22, the spring 52 urges the lock body 54 towards the ratchetwheel 42 so that the lock pin 46 engages a serration 44 on the ratchetwheel 42 to lock the housing 22 and the tube 24 in position.

When a higher fixed position is desired, an upwardly directed force isapplied to the tube 24. As the tube is pushed upward the housing 22 andtube 24 rotate about the centerline of the ratchet wheel 42. As theupward force is applied to the tube 24, the protruding end 47 of thelock pin 46 follows the rounded upper edge of the serration 44 slightlycompressing the spring 52 until the next serration 44 is reached. Oncethe next serration 44 is reached, the spring 52 urges the lock pin 46into the next serration 44 to lock the housing 22 and tube 24 in the newangular position. The procedure is repeated if yet a higher fixedposition is desired.

Because of the serration 44 has a radially extending lower edge, thetube 24 cannot be lowered by merely applying a downward force on thetube 24. Therefore, a ratchet release 60 is provided to disengage thelock pin 46 from the serration 44. Once the lock pin 46 is disengagedthe tube 24 can be lowered. The ratchet release 60 comprises a tractionrod 62, a cam 64, and a cam base 66 as seen in FIGS. 2 and 3. Thetraction rod 62 is an elongated rod with a diameter sized to fit withinthe tube 24. A first end of the traction rod 62 is fixed to the lockbody 54. In the preferred embodiment, the end of the traction rod 62 isthreaded 74 and mates to an internally threaded hole formed in the smalldiameter end of the lock body 54 and is spot welded.

The cam 64 and the cam base 66 are tubularly shaped having an innerdiameter sized to slide over the outer diameter of the tube 24. Theupper surface 67 of the cam base 66 is angled in relation to itscenterline. The lower surface 65 of the cam 64 is angled in relation toits centerline so that it will contact and mate with the upper surface67 of the cam base 66. The cam base 66 forms three internally threadedholes located 90 degrees from each other and sized to cooperate with setscrews 68, 69, 71. The set screws 68, 69, 71 prevent movement of the cambase 66 relative to the tube 24.

The cam 64 is connected 82 to a second end 76 of the traction rod 62. Inthe preferred embodiment the connection 82 is made by an end cap 78. Theend cap 78 has a cylindrical portion with a diameter sized to fit withinthe inner diameter of the tube 24 and a flange portion with a diametersized to retain the cam 64 on the tube 24. The cylindrical portion ofthe end cap 78 forms an internally threaded hole which mates withthreads formed by the second end 76 of the traction rod 62. The cam base66 position along the axis of the tube 24 is adjusted to ensure that thecam 64 is constrained between the cam base 66 and the end cap 78.Preferably a polytetrafluoroethylene, commercially sold as TEFLON,washer 80 is located between the cam 64 and end cap 78. The TEFLONwasher 80 reduces the friction between the cam 64 and end cap 78 andthereby eases the rotation of the cam 64.

It will be observed that other embodiments of the connection 82 betweenthe cam 64 and traction rod 62 known to those skilled in the art arepossible. For example, the end cap 78 could be rigidly attached to thecam 66 with the traction rod 62 passing through the end cap 78 having arestraint attached to restrain the end cap 78 and cam 64.

The lock pin 46 disengaged from the ratchet wheel 42 is best shown inFIG. 4. As seen in FIGS. 2 and 4, to release the ratchet mechanism 40, ahandle 70 provided with a grip 72 is turned to rotate the cam 64 aboutthe tube 24. As the cam 64 rotates, the cam's angled contact surface 65rides up the angled contact surface 67 of the cam base 66. As the cam 64rides up the cam base 66, the end cap 78 is urged outward thus causingthe traction rod 62 to pull the lock body 54 outward by compressing thespring 52 until the lock pin 46 disengages from the serration 44 on theratchet wheel 42. Once the lock pin 46 is disengaged, the housing 22 andthe tube 24 can be rotated downward about the ratchet wheel 42 to a newvertical position. The handle 70 is then turned in the oppositedirection to return the cam 64 and traction rod 62 back to theiroriginal position causing the spring 52 to urge the lock pin 46 backinto engagement with the ratchet wheel 42 serration 44 at the newvertical position.

As seen in FIG. 2, the attachment 90 consists of a post 92 having a bendand is secured to the ratchet wheel 42. The post 92 is preferably bentsuch that an end portion 93 angularly extends from the rotational planeabout the ratchet wheel 42 when the post 92 is firmly attached to theratchet wheel 42. The post 92 is bent preferably an angle in the rangeof 10 degrees to about 30 degrees, and more preferably, an angle ofabout 20 degrees. It will be noted that the post could be bent to otherangles. The post 92 is bent so that the vertically adjustable support 8extends outwardly from the side of the table 14 to which it is attached(FIG. 5). This positions the stirrup or boot 10 to automatically abductor separate the limbs of the patient.

In the preferred embodiment, the post 92 is secured by a threaded andpinned end 95 which mates to an internally threaded hole formed in theratchet wheel 42. It will be noted that the post 92 could be secured byother methods known to those skilled in the art. For example, the post92 could be welded to the ratchet wheel 42. The post 92 extends from theratchet wheel 42 through an opening 96 formed by the housing 22. Thepost 92 length is sized to locate the adjustable vertical support 8 at arange of desired heights. The post end portion 93 preferably is knurledto allow the post 92 to be more readily clamped to the operating roomtable 14 (as seen in FIGS. 2 and 5).

It will be observed that other embodiments of the attachment 90 known tothose skilled in the art are possible. For example, the attachment 90could consist of a bracket with two flanges that are rigidly fixed toopposing sides of a ratchet wheel that extends out of the two openingsof the housing's 22 first cavity. The lower side of the bracket couldhave a pin that would allow rotation of the system and easily be clampedto the operating room table 14

In the preferred embodiment a thread locking compound is applied to thethreaded connections between the tube housing 30 and the housing 22, thetraction rod 62 and the end cap 78, and the post 92 and the ratchetwheel 42, as seen in FIG. 2. Other fastener locking devices known tothose skilled in the art are possible and could be utilized to preventthe loosening of the threaded connections after repeated usage of thevertically adjustable support 8.

As shown in FIG. 5, the boot 10 is provided with a transverselyextending connecting rod 11. Preferably the connecting rod 11 is welded,or otherwise connected, to a bracket 13 fastened to the boot 10. Whenthe connecting rod 11 is retained within the adjustable support 12, theboot 10 can generally float or freely rotate about the axis of theconnecting rod 11.

As seen in FIG. 6, the preferred embodiment of the adjustable support 12comprises a retaining block 79, a compression block 84, a compressionhead 86, a washer 91, and two set screws (not shown). Each block definesa cylindrical passage 83, 85 for receiving the connecting rod 11 andtube 24 respectively. The cylindrical passage 83 in the retaining block79 is sized to contain the connecting rod 11 secured to the limb supportor boot 10 (as seen in FIG. 5). The cylindrical passage 85 in thecompression block 84 is sized to receive the tube 24 of the verticaladjustable support 8 (as seen in FIG. 5). The compression block 84defines a slot 89 which extends from one edge of the compression block84 to the cylindrical passage 85. The blocks 79, 84 further define ahole 77 at right angles to the cylindrical passages 83, 85, and throughthe slot 89. The hole 77 is internally threaded at a portion within theretaining block 79. The retaining block 79 also defines two internallythreaded holes or openings (not shown) extending from a back surface tothe cylindrical passage 83 to cooperate with the set screws. One setscrew contacts the boot connecting rod 11 to control the ease ofrotation of the boot 10 about the axis of the connecting rod 11 and theother set screw controls the angle.

As seen in FIG. 6, the compression head 86 has a threaded member 81 anda handle 87. The threaded member 81 is inserted through the hole 77 andcooperates with the internal threads defined in the retaining block 79.The washer 91 is located on the threaded member 81 between thecompression head 86 and the compression block 84 to decrease frictionand provide smoother tightening of the compression head 86. Preferablythe washer is made of nylon. When the compression head 86 is tightened,the slot 89 closes slightly to the lock orientation and position of theadjustable support 12 relative to the tube 24 of the vertical adjustablesupport 8. When the compression head 86 is not tightened, the adjustablesupport 12 can translate along the tube 24 of the vertical adjustablesupport 8 and can be rotated about the tube 24. Additionally theretaining block 79 and compression block 84 can be rotated relative toeach other in the unlocked position.

Referring to FIG. 5, the invention is shown in a leg supportapplication. The vertically adjustable support 8 is in the zero degreeor horizontal position. The post 92 is removably secured in socket 16and rotationally held by clamp 18. The socket 16 is typically a fittinglocated on the side of an operating room table 14. Due to the bend inthe post 92, the vertically adjustable support 8 extends angularlyoutwardly from the side of the table 14. The adjustable support 12 isreceived on the tube 24 of the vertically adjustable support 8. Theadjustable support receives the connecting rod 11 which is secured.

A second adjustable limb support system according to the invention istypically secured to the opposed side of the table 14 in the same mannerby a post bent in the opposite direction (not shown). In thisconfiguration a patient lies with their back on the table and a legportion or foot in each boot.

As seen in FIG. 5, the orientation and position of the leg, can beadjusted by both the adjustable support 12 and the vertically adjustablesupport 8. The surgeon can unlock the adjustable support 12 by turningthe handle 87. The adjustable support 12 can then be translated along orrotated about the axis of the tube 24. The retaining block 79 andattached boot 10, can also be rotated relative to the compression block84 about an axis perpendicular to both the axis of the connecting rod 11and the axis of the tube 24. Additionally, or alternately, the surgeoncan raise the adjustable support 12 to any of the fixed positions orvertical heights by pushing upwardly on the tube 24. The verticallyadjustable support 8 automatically locks into one of the fixed positionsor vertical heights. When the desired orientation and position of thelimb support 10 are obtained, the adjustable support system 12 is lockedby turning the handle 87 back to the tightened position. It should benoted that the boot 10 floats or is free to swing or rotate about theaxis of the connecting rod at all times. Therefore, the verticallyadjustable support 8 can be raised or lowered in many situations withoutunlocking the adjustable support 12 because the floating or swingingboot 10 will automatically adjust for the new position.

If necessary, the surgeon can lower the vertically adjustable support 8to one of the fixed positions or vertical heights by turning the handle70. When a desired position is obtained the handle 70 is returned to itsoriginal position and the tube 24 is locked in place. The abovedescribed adjustments can be made in any combination and whenever thesurgeon desires the limb to be in a new orientation or position. As canbe seen by the above described adjustments, they can be readily made byone person during surgery.

An adjustable limb support system 100 according to a second embodimentof the invention is shown in FIG. 10. The system 100 includes avertically adjustable support 102, an adjustable support 12 and a boot10. The adjustable support 12 and the boot 10 are the same as describedabove in the description of the first embodiment. The verticallyadjustable support 102 includes a support arm 104, such as a tube orrod, and a ratcheting table clamp 106. The table clamp 106 secures thevertically adjustable support 102 to a side rail 108 of operating roomtable 110.

The ratcheting table clamp 106 is shown in FIGS. 7, 8, and 9. As bestseen in FIG. 7, the table clamp 106 includes an attachment 112 which hasa clamping portion 114 that is generally C-shaped in cross-section andis sized and shaped to receive the side rail 108 of the table 110 (FIG.10). A threaded rod 116 extends through a threaded opening 118 (FIG. 9)in the closed side of the clamping portion 114. The rod 116 has a firstend within the clamping portion 114 that has an increased diameter. Theincreased diameter provides a clamping surface 120 for contacting theside rail 108 of the table 110 and also prevents the first end of therod 116 from passing through the threaded opening 118 in the clampingportion 114. A second end of the threaded rod is provided with a handle122 such that the rod 116 can be rotated to move the clamping surface120 toward and away from the open end of the clamping portion 114.

An alternative and preferred clamping portion 214 is shown in FIGS. 11and 12. The clamping portion 214 is generally C-shaped in cross-sectionand is sized and shaped to receive the side rail 108 of the table 110(FIG. 10). Opposed walls 216 downwardly extend from the bottom of theclamping portion 214 to form an open space 218. A shaft 220 extendsthrough openings in the opposed walls 216. An eccentric cam 222 isattached to the shaft 220 within the open space 218 by fastener 224.Attached to an outer end of the shaft 220 is a handle 226. A pin 228 hasa first end 230 extends through an opening 232 in the clamping portion214. A second end 234 of the pin 228 has an enlarged diameter whichcontacts the cam 222. A helical coil spring 236 is located on the pin228 within the open space 218 to bias the second end of the pin 228towards the cam 222. When the large diameter of the cam 222 is vertical(FIG. 12), the pin 228 is in its uppermost position within the clampingportion 214. The pin 228 is sized to clamp the side rail 108 of thetable 110 (FIG. 10) when in this position. The cam 222 is sized andshaped to retain the shaft 220 between the walls 216 and provide anadequate distance of axial travel for the pin 228. To unclamp the siderail 108 of the table 110 (FIG. 10), the handle 226 is rotated to rotatethe shaft 220 and cam 222 until the small diameter of the cam 222 is inthe vertical position (FIG. 11). As the cam 222 rotates, the spring 236biases the pin 228 against the cam 222 so that the first end 230 of thepin 228 moves downward until it is no longer within the clamping portion214. Preferably, a pair of pins 238 are provided at the top of theclamping portion 214 to provide an upper clamping surface for the siderail 108 of the table 110 (FIG. 10).

As best seen in FIGS. 7 and 9, the attachment 112 also includes amounting portion 124 and a spacer portion 126 connecting the mountingportion 124 to the clamping portion 114. The mounting portion 124 iscylindrically-shaped and has an opening 128 in which the rod 116 passesthrough to the threaded opening 118 of the clamping portion 114. Thespacer portion 126 is generally wedge-shaped and circular incross-section. The diameter of the mounting portion 124 is smaller thanthe diameter of the spacer portion 126 forming an annularly-shaped seat130. The spacer portion 126 is angled such that the mounting portion 124is angled downwardly. The spacer portion 126 is preferably sized suchthat the axis of the mounting portion 124 is angled downwardly. The axisis preferably angled in the range from about 10 degrees to about thirtydegrees and more preferably the axis is angled about 20 degrees. It willbe noted that the spacer portion 126 could be sized for other angles.This angle causes the rotational plane of the vertical adjustablesupport 102 to extend outwardly at an angle from the side of the table110 to automatically abduct the limbs of the patient as described abovein the description of the first embodiment.

As best seen in FIG. 9, a ratchet mechanism 132 is fixed to theattachment 112 and allows the support arm 104 to rotate to fixed angularpositions. The ratchet mechanism 132 includes a ratchet wheel 134 and alock pin 136. An inner diameter of the ratchet wheel 134 is sized toreceive the mounting portion 124 of the attachment 112 such that theratchet wheel 134 is adjacent or near the seat 130. A mounting screw 138extends from the ratchet wheel 134 to the mounting portion 124 of theattachment 112 to prevent rotation of the ratchet wheel 134. The outerdiameter of the ratchet wheel 134 has a plurality of serrations 140.Each serration 140 has an angled upper edge and an angled lower edge.The ratchet wheel 134 of the illustrated embodiment has sixteenserrations 134 to lock the support arm 104 in sixteen fixed angularpositions. The serrations are located so that the support arm isrotatable over an arc of about 180 degrees that is from about horizontalto about horizontal. It will be noted that a greater or fewer number offixed angular positions could be provided or a greater, smaller, ordifferent arc could be provided. Additionally, a limit to the angularpositions that reduces patient risk due to excess hip flexion could alsobe provided as described above in the description of the firstembodiment.

The lock pin 136 is generally cylindrically-shaped and has a protrudingend 142 shaped to engage the ratchet wheel serrations 140. The lock pin136 is urged into the serration 140 by a spring element 144. The springelement 144 is preferably a helical coil compression spring having aninner diameter sized to surround the lock pin 136 and is held on thelock pin 136 by a retaining ring 146.

As seen in FIGS. 7-9, the table clamp 106 also includes a housing 148which supports the support arm 104. The housing 148 has a generallycylindrically-shaped first portion 150 and generallyrectangularly-shaped second portion 152 radially extending from thefirst portion 150. The first portion 150 has a cylindrically-shapedcavity 154 open at both ends with a diameter sized to receive theratchet wheel 134. The housing 148 is retained about the ratchet wheel134 by a cover plate 156 and a retaining ring 158. The cover plate 156has an outer diameter generally equal to the diameter of the firstportion 150 of the housing 148. The cover plate 156 is fixed to themounting portion 124 of the attachment 112 by four mounting screws 160extending into threaded openings 162 in the mounting portion 124 of theattachment 112. Spacers 164 are provided to space the cover plate 156 anadequate distance from the mounting portion 124 of the attachment 112.The retaining ring 158 is annularly-shaped having an outer diametergenerally equal to the first portion 150 of the housing 148 and an innerdiameter sized to receive the mounting portion 124 of the attachment112. The retaining ring 158 is located between the seat 130 of theattachment 112 and the housing 148. Assembled in this manner the housing148 is free to rotate about the ratchet wheel 134 on the axis of themounting portion 124. Rotation of the housing 148 is limited by a stopsuch as slot 166 in the first portion 150 of the housing 148 and a screw168 fixed to the ratchet wheel 134 as best seen in FIG. 9. The housing148 is rotatable until the screw 168 contacts an end of the slot 166.The slot 166 is sized and located so that the housing 148 is rotatableonly over an arc where the lock pin 136 engages the serrations 140 ofthe ratchet wheel 134.

The second portion 152 of the housing 148 has first and second bores170, 172 perpendicular to the cavity 154 of the first portion 150. Thefirst bore 170 is open at both ends and opens into the cavity 154. Thefirst bore 170 has a step 174 between two diameters. A first diameter isadjacent the cavity 154 and is sized for receiving the spring element144 and a second diameter is sized for receiving the lock pin 136. Thesecond bore 172 is a blind bore and is sized to receive an end of thesupport arm 104. A support 176 having a threaded opening 178 is fixed,such as by welding, to the housing 148 adjacent an opening 180 whichopens into the second bore 172. A threaded rod 182 extends cooperateswith the threaded opening 178 of the support to clamp the support arm104 within the second bore 172. A handle 184 is provided at an outer endof the rod 182 such that the rod 182 can be turned to move the rod 182into and out of the second bore 172.

A ratchet release 186 is provided which disengages the lock pin 136 fromthe serration 140 and allows the support arm 104 to rotate back to thefixed angular positions. The ratchet release 186 includes a knob 188located at an outer end of the lock pin 136. When the knob 188 is pulledoutwardly with a force adequate to overcome the spring element 144, thespring element 144 is compressed against the step 174 and the protrudingend 142 of the lock pin 136 disengages from the serration 140 of theratchet wheel 134. Outward movement of the lock pin 136 is limited by apin 190 fixed to the housing 148 which engages an end of an axiallyextending groove 192 on the lock pin 136.

Referring to FIG. 10, the invention is shown in a leg supportapplication. The ratcheting table clamp 106 is removably secured to theside rail 108 of the operating room table 110 and the support arm 104 isreceived by table clamp 106. Due to the angle of the table clamp 106,the support arm 104 extends angularly outwardly in a lateral directionfrom the side of the table 110. The adjustable support 12 is received onthe support arm 104 of the vertically adjustable support 102. Theadjustable support 12 receives the connecting rod 11 of the boot 10. Asecond system according to the invention is typically secured to theopposed side of the table (not shown). The second system is a mirrorimage of the first such that the support arm extends outwardly in alateral direction from the opposed side of the table. In thisconfiguration a patient lies with their back on the table and a legportion or foot in each boot 10.

The orientation and position of the leg can be adjusted by both theadjustable support 12 and the vertically adjustable support 102 asdescribed above for the first embodiment. To disengage the ratchetmechanism, however, the knob 188 (FIG. 10) is pulled instead of turningthe handle 70 (FIG. 5).

Although particular embodiments of the adjustable limb support systemhave been illustrated and described in detail, it will be understoodthat the invention is not limited correspondingly in scope, but includesall changes and modifications coming within the spirit and terms of theclaims appended hereto.

What is claimed is:
 1. An adjustable limb support system for anoperating room table, said support system comprising:a limb support; anadjustable support for orienting said limb support; and a verticallyadjustable support for positioning said limb support and said adjustablesupport in at least two fixed positions, said vertically adjustablesupport comprising a support arm secured to said adjustable support anda ratcheting table clamp, said ratcheting table clamp including aratchet wheel having a central axis at an angle relative to horizontal,a housing rotatable about said central axis of said ratchet wheel andhaving first and second bores perpendicular to the central axis of theratchet wheel, a lock pin carried within said first bore of said housingand engaging said ratchet wheel to allow only upward rotation of saidhousing to said fixed positions, a ratchet release for disengaging saidlock pin from said ratchet wheel to allow downward rotation of saidhousing to said fixed positions, means for removably securing saidsupport arm within in said second bore, and an attachment fixed to saidratchet wheel for securing said vertical adjustable support to theoperating room table.
 2. The adjustable support system according toclaim 1, wherein said second bore of said housing is a blind bore. 3.The adjustable limb support system according to claim 1, wherein saidaxis rotation is at an angle of about twenty degrees from horizontal. 4.The adjustable limb support system according to claim 1, wherein saidattachment has a clamping portion generally C-shaped in cross-sectionwith closed and open sides, said closed side of said clamping portionhaving a threaded opening, and said attachment has a threaded rodcooperating with said threaded opening such that rotation of said rodmoves an end of said rod toward and away from said open side of saidclamping portion.
 5. The adjustable support system according to claim 4,wherein said rod has a handle for rotating said rod.
 6. The adjustablesupport system according to claim 4, wherein said attachment has amounting portion angularly extending from said clamping portion, saidratcheting mechanism being fixed to said mounting portion.
 7. Theadjustable limb support system according to claim 1, wherein said meansfor removably securing said support arm in said second bore includes athreaded opening in said housing at said second bore and a threaded rodcooperating with said threaded opening such that rotation of said rodmoves an end of said rod into and out of said second bore for removablyclamping said support arm in said second bore.
 8. The adjustable supportsystem according to claim 7, wherein said rod has a handle for rotatingsaid rod.
 9. The adjustable support system according to claim 1, whereinsaid ratchet release comprises a knob fixed to said lock pin foroutwardly pulling said lock pin to disengage said lock pin from saidratchet wheel.
 10. The adjustable support system according to claim 1,wherein said central axis of said ratchet wheel is at an angle tohorizontal in the range of about 10 degrees to about 30 degrees.
 11. Theadjustable support system according to claim 1, wherein said housing hasa stop for limiting rotation of said housing and said support arm aboutsaid ratchet wheel.
 12. The adjustable support according to claim 11,wherein said support arm rotates upwardly from about horizontal forabout 180 degrees.
 13. The adjustable support system according to claim11, wherein said support arm rotates to a maximum angle of about 78degrees relative to said operating room table for reducing patient risk.14. A ratcheting table clamp for securing an end of a support arm to anoperating room table, said table clamp comprising:a ratchet wheel havinga central axis at an angle relative to horizontal and a periphery with aplurality of serrations; a housing rotatable about said central axis ofsaid ratchet wheel having first and second bores generally perpendicularto the central axis of the ratchet wheel, said second bore sized forreceiving the end of the support arm; a lock pin carried by said housingwithin said first bore and having a protruding end adapted for engagingsaid ratchet wheel to allow rotation of said housing in only onedirection; a spring element for urging said protruding end of said lockpin into engagement with said serrations; a knob secured to said lockpin for disengaging said lock pin from said ratchet wheel to allowrotation of said housing; and an attachment fixed to said ratchet wheelhaving a clamping portion for clamping to the operating room table. 15.The table clamp according to claim 14, wherein said second bore of saidhousing is a blind bore.
 16. The table clamp according to claim 14,wherein said central axis of said ratchet wheel is at an angle tohorizontal in the range of about 10 degrees to about 30 degrees.
 17. Thetable clamp according to claim 14, wherein said central axis of saidratchet wheel is at an angle of about twenty degrees from horizontal.18. The adjustable limb support system according to claim 14, whereinsaid clamping portion is generally C-shaped in cross-section with closedand open sides, and said attachment has a pin extending into saidclamping portion perpendicular to said closed and open sides, arotatable eccentric cam, and a spring for biasing said pin against saidcam, said cam cooperating with said pin such that rotation of said cammoves an end of said pin within said clamping portion.
 19. Theadjustable limb support system according to claim 14, wherein saidhousing has a threaded opening at said bore, and a threaded rodcooperating with said threaded opening such that rotation of said rodmoves an end of said rod into and out of said bore for removablyclamping said support arm in said bore.
 20. The adjustable supportsystem according to claim 14, wherein said housing has a stop forlimiting rotation of said housing about said ratchet wheel.